=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851598114
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHEST DISEASES AND INTERNAL MEDICINE, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2007
-----------------------------------------------------
Last Update Date | 02/22/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 800 OAK ST
-----------------------------------------------------
City | FARMVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23901-1199
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-392-7859
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 353
-----------------------------------------------------
City | FARMVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23901-0353
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-392-7859
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | CINDY COOK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 434-392-7859
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0200X
-----------------------------------------------------
Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | 0101047394
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RS0012X
-----------------------------------------------------
Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | 0101047394
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | 0101047394
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------